Nurse Reviewer, Inpatient Utilization & Medical Necessity
Hawaii Medical Service Association
Hawaii Medical Service Association is seeking a Concurrent Nurse Reviewer for the Facility Utilization Review Unit. The role requires applying clinical and policy criteria to determine the appropriateness of inpatient stays and suspended claims for HMSA members. Under minimal supervision, you will coordinate with medical directors, case management, and other teams, ensuring accurate documentation and adherence to accrediting and regulatory guidelines. Hawaii licensure is required. #J-18808-Ljbffr Hawaii Medical Service Association
- ...Health is seeking a Clinical Guide Part A to support inpatient, behavioral health, and post-acute utilization review in alignment with CMS guidelines. This remote,... ...regulatory compliance and collaboration with Medical Directors to ensure timely, appropriate care. #J...MedicalRemote jobFull time
- ...to better care.? Requirements The Nurse Reviewer performs complex medical record reviews of Medicare Part A/... ...apply clinical judgment to medical necessity, coverage, and appropriateness-of-... ...-payment claims reviews and/or utilization review Preferred Qualifications MAC...MedicalContract workFor contractorsLocal areaRemote work
$78k - $85k
...a talented individual for a Nurse Reviewer - Itemized Bill Review role to perform reviews of medical records, healthcare claims, itemized... .... Perform level‑of‑care and utilization reviews by analyzing medical... ...of clinical experience in an inpatient hospital setting required. 1...MedicalFull timeWork from homeFlexible hours- ...-Time Psychiatric Nurse Practitioner! Springwoods... ..., provides acute inpatient treatment for... ...therapy and/or medication management as needed... ...established protocols and utilizes evidence-based... .... Explains the necessity, preparation,... ...quality assurance review through monitoring...MedicalFull timeWeekend work
- ...PRN (as needed). JOB SUMMARY The Utilization Review Nurse reviews medical records and treatment plans to ensure... ...will be responsible for reviewing inpatient and outpatient authorizations. The... ...to assess the appropriateness and necessity of care. Evaluate the proposed or...MedicalReliefLocal areaRemote work
$44.63 - $53.55 per hour
## Utilization Management Nurse, RNApplylocations: Remotetime type: Full... ...Physicians, Altais Medical Group Riverside, and... ...Perform Utilization Review activities... ...additional medical necessity information and research... ...nursing staff Support Inpatient Care Management, Network...MedicalLocal areaFlexible hours$90k - $107k
...including doctors, nurses, business people,... ...drive groundbreaking medical discoveries and... ...network adequacy review and authorization... ...who require planned inpatient or outpatient services... ...providers. Utilizing clinical knowledge... ...requests, assess medical necessity and benefit...MedicalWork at officeRemote workFlexible hoursShift work$25 - $31 per hour
...certification, every inpatient stay, every appeal that... ...a moment where your review decides what happens... ...what keep the entire utilization review process trustworthy... ...abuse, skilled nursing, and rehab stays, for medical appropriateness and necessity. Drive post-service reviews...MedicalHourly payMonday to Friday$34 - $37 per hour
JOB SUMMARY The On-Call Inpatient Care Manager Licensed Vocational Nurse (LVN) is a California-... ...providing after-hours medical management support under... ...leadership. The role supports utilization management (UM), care... ...processes and medical necessity documentation...MedicalHourly payWork experience placementWork at officeNight shiftWeekend workAfternoon shift- ...Moffitt Cancer Center in Tampa, FL seeks an Utilization Review Nurse to perform initial, concurrent, and retrospective reviews ensuring medical necessity and appropriate care levels. You will collaborate with case management, physician advisers, providers, and payers to...Medical
$55 - $65 per hour
...Registered Nurse With Utilization Review Experience A healthcare organization is seeking a Registered Nurse with utilization review experience... ...will have experience reviewing healthcare services for medical necessity, appropriateness, and utilization. Responsibilities:...MedicalHourly payContract work- MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective reviews for designated health plans... ...continued care, and collaborate with a multidisciplinary team to ensure medical necessity #J-18808-Ljbffr Marin General HospitalMedical
- Carson Valley Health in Nevada seeks a Per Diem Utilization Review RN to perform clinically oriented medical chart reviews and support the hospital's utilization review plan, ensuring medical necessity and proper documentation. Requirements include Nevada RN licensure,...MedicalHourly payDaily paid
- Commence is seeking a Nurse Reviewer to perform complex medical record reviews of Medicare Part A/B and DMEPOS claims. The role requires clinical judgment to assess payment validity according to CMS guidelines. The position is remote, offering flexibility while demanding...MedicalRemote job
- ...embarked on a program where we are looking for Registered Nurses to perform reviews and clinical summaries for disability claims. The expected... ...based need. Job Summary A clinical summary of the relevant medical documentation for the period under review. Based on client...MedicalWork experience placement
$2,868 per week
...Prime Staffing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in New York City, New York. Job Description... ...: Strong understanding of insurance guidelines, medical necessity criteria (e.g., InterQual or MCG), and discharge planning...MedicalPermanent employmentTemporary workZero hours contractShift work- University of Kentucky is seeking an Inpatient Clinical Documentation Specialist II to ensure accuracy, quality, and... ...severity of illness, risk of mortality, and medical necessity. The role involves chart reviews, data reporting, and presenting findings to leadership...MedicalRemote job
- ...Performs clinically orientated medical chart reviews and other administrative... ...of the medical center's utilization review plan, state and federal... ...: A Bachelor's Degree in Nursing preferred; three (3) years... ...record review for medical necessity. Knowledge of basic ICD-10...MedicalHourly payDaily paidWork experience placement
$7.5k
Additional Job Description Sentara Williamsburg Regional Medical Center Inpatient Surgical - Registered Nurse FULL TIME NIGHTS UP TO $20,000 Bonus $7,500 for... .../nursing research, quality, evaluation, resource utilization, and environmental health) encompass the actions...MedicalFull timeNight shift- Personify Health is hiring an LVN-licensed reviewer to assess outpatient, inpatient, and mental health pre-certifications for medical appropriateness and necessity. You will also drive post-service reviews to verify medical necessity, escalate complex cases, and coordinate...Medical
- Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective...MedicalRemote jobFull timeContract work
- ...BlueCross BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical necessity using established guidelines. The role documents decisions and supports utilization review across multiple services. The position is...MedicalRemote jobFull time
$77.02k - $117.58k
...named one of the Tampa Bay Times’ Top Workplaces. Summary The Utilization Review Nurse is responsible for performing initial, concurrent, and retrospective utilization reviews to determine medical necessity, appropriate level of care, and continued stay in accordance with...MedicalFull timeWork at office$110k
...and with the most efficient utilization of resources. Carries out activities... ...for justification. Reviews the patient’s plan of care in... ...patient. Plans transfers to nursing facilities, rehab and other... ...Documents level of care and medical necessity in the Care Management database...MedicalDaily paidFull timePart timeFlexible hoursShift work$77.08k - $119.47k
## Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY... ...Refers cases and issues to Medical Director and Triad Team in compliance... ...:** • Registered nurse with a New York State current... ...utilize. • Understanding of Inpatient versus Outpatient surgery and...MedicalShift work$66.83k - $111.38k
...and holiday coverage required. Nurses participate in a self‑... ...Wyoming. Job Responsibilities Utilization Review Nurse is responsible for utilizing... ...of prior authorization, inpatient review, concurrent review, retrospective review, medical director referrals and execution...MedicalPermanent employmentFull timeTemporary workRemote workShift workDay shift- ...accountability for the delivery of nursing care through the use of the... ...care for patients in an inpatient hospital setting. Minimum Qualifications... ...effectiveness of education. Utilizes Evidence‑Based Practice (EBP)... ...Unit Address: 1 Medical Center Drive Morgantown West...MedicalLocal areaFlexible hoursShift workDay shift
- MAJOR RESPONSIBILITIES & DUTIES Utilizes a systematic approach to nursing practice incorporating assessment,... ...assessment. Formulates plan of care and reviews and revises plan on an ongoing... ...two-way communication between Inpatient Medical Unit staff and assigned committee...MedicalReliefShift work
- ## Inpatient RN Radiology RGVApplylocations: Edinburg... ...joining our team! Please review the job information... ...Purpose of Job:**The staff nurse is a professional... ...department. The staff nurse, utilizing the nursing process,... ...(PA), Physicians and Medical/Nursing Assistants and...MedicalImmediate startFlexible hoursShift workNight shiftAfternoon shift
- ...About This Opportunity: As a Utilization Management Nurse, you’ll oversee and manage... ...participants. You will review UM activities, including prospective... ...of care for all inpatients through early discharge planning... ...company-sponsored Medical, Dental, and Vision insurance...MedicalFull timeImmediate startRemote workMonday to FridayFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Nurse Reviewer, Inpatient Utilization & Medical Necessity. Be the first to apply!
- advanced medical Brooklyn, NY
- correctional medical services Brooklyn, NY
- medical benefits Brooklyn, NY
- medical terminology Brooklyn, NY
- one medical Brooklyn, NY
- medical office no experience Brooklyn, NY
- medical electronics Brooklyn, NY
- event medical Brooklyn, NY
- pediatric medical Brooklyn, NY
- medical humanities Brooklyn, NY


